How Willing Are Doctors To Give Patients with Terminal Cancer Accurate Information about Their Chances of Survival?

The summary below is from the full report titled “Prognostic Disclosure to Patients with Cancer near the End of Life.” It is in the 19 June 2001 issue of Annals of Internal Medicine (volume 134, pages 1096-1105). The authors are EB Lamont and NA Christakis.

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What is the problem and what is known about it so far?

Patients with terminal or end-stage cancer sometimes do not understand their actual chances of survival. This misunderstanding can affect their decisions regarding treatments and end-of-life care. Patients may misunderstand their survival chances for several reasons. For example, some patients may continue to believe they will be cured despite being told otherwise. Families may sometimes contribute to patients' misunderstandings by hiding or downplaying negative information. Moreover, doctors may not discuss survival chances with patients, or they may give patients inaccurate information. Few studies have investigated doctors' willingness to give terminally ill patients information about their chances of survival.

Why did the researchers do this particular study?

To find out how often physicians would willingly give patients with terminal cancer their best estimates of how long the patients are likely to survive.

Who was studied?

The study included 258 physicians who cared for 326 patients with terminal cancer. Physicians included generalists (internists and family practitioners), oncologists (specialists in cancer), gynecologists, and surgeons. Eighty percent of the physicians were men.

How was the study done?

The researchers asked the physicians to estimate the chances of survival for each of their 326 patients. The physicians were also asked what they would tell these patients if either the patient or a family member insisted on receiving a specific estimate of survival. The researchers then compared the physicians' estimates of survival with what the physicians said they would actually tell their patients.

What did the researchers find?

Physicians said they would withhold information altogether about survival estimates from 23% of their patients. They said they would tell 37% of their patients their actual survival estimates and would give survival estimates different from the ones they actually estimated to 40% of their patients. In these latter instances, physicians most often said they would give patients estimates that were longer than their actual estimates. Physicians said they would more often have frank discussions with older than younger patients. Female physicians and physicians who had treated many patients with terminal cancer were least likely to favor frank discussions with their patients.

What were the limitations of the study?

This study was based on what physicians said they would do rather than what they actually did; whether their thoughts of what they would do match their actual practice is not known. Also, it is difficult for physicians to make exact estimates of how long individual patients will survive.

What are the implications of the study?

Physicians who care for patients with terminal cancer say that they would often not provide such patients their best estimates of survival. Failing to share that information may contribute to patients' misunderstanding about their chances of survival and may affect their decisions about cancer treatment.

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